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Comparative Study
. 2023 Dec 29;140(6):1726-1735.
doi: 10.3171/2023.10.JNS231702. Print 2024 Jun 1.

Endovascular treatment of acute ischemic stroke patients with tandem lesions: antegrade versus retrograde approach

Milagros Galecio-Castillo  1 , Michael Abraham  2 , Mudassir Farooqui  1 , Ameer E Hassan  3 , Afshin A Divani  4 , Mouhammad A Jumaa  5 , Marc Ribo  6 , Nils Petersen  7 , Johanna Fifi  8 , Waldo R Guerrero  9 , Amer M Malik  10 , James E Siegler  11   12 , Thanh N Nguyen  13 , Sunil A Sheth  14 , Albert J Yoo  15 , Guillermo Linares  16 , Nazli Janjua  17 , Darko Quispe-Orozco  1 , Abid Qureshi  2 , Wondwossen G Tekle  3 , Asad Ikram  4 , Syed F Zaidi  5 , Cynthia B Zevallos  1 , Belen Taborda  6 , Alex Devarajan  8 , Linda Zhang  12 , Mohamad Abdalkader  13 , Sergio Salazar-Marioni  14 , Jazba Soomro  15 , Weston Gordon  16 , Aaron Rodriguez-Calienes  1   18 , Juan Vivanco-Suarez  1 , Katrina Woolfolk  17 , Maxim Mokin  9 , Dileep R Yavagal  10 , Santiago Ortega-Gutierrez  1
Affiliations
Comparative Study

Endovascular treatment of acute ischemic stroke patients with tandem lesions: antegrade versus retrograde approach

Milagros Galecio-Castillo et al. J Neurosurg. .

Abstract

Objective: The optimal technique for treating tandem lesions (TLs) with endovascular therapy is debatable. The authors evaluated the functional, safety, and procedural outcomes of different approaches in a multicenter study.

Methods: Anterior circulation TL patients treated from January 2015 to December 2020 were divided on the basis of antegrade versus retrograde approach and included. The evaluated outcomes were favorable modified Rankin Scale (mRS) score (mRS score 0-2) at 3 months, ordinal shift in mRS score, successful recanalization, excellent recanalization, first-pass effect (FPE), time from groin puncture to successful recanalization, symptomatic intracranial hemorrhage (sICH), and 90-day mortality.

Results: Among 691 patients treated at 16 centers, 286 patients (174 antegrade and 112 retrograde approach patients) with acute stenting were included in the final analysis. There were no significant differences in mRS score 0-2 at 90 days (52.2% vs 50.0%, adjusted odds ratio [aOR] 0.83, 95% CI 0.42-1.56, p = 0.54), favorable shift in 90-day mRS score (aOR 1.03, 95% CI 0.66-1.29, p = 0.11), sICH (4.0% vs 4.5%, aOR 0.64, 95% CI 0.24-1.51, p = 0.45), successful recanalization (89.4% vs 93%, aOR 0.49, 95% CI 0.19-1.28, p = 0.19), excellent recanalization (51.4% vs 58.9%, aOR 0.59, 95% CI 0.40-1.07, p = 0.09), FPE (58.3% vs 69.7%, aOR 0.62, 95% CI 0.44-1.15, p = 0.21), and mortality at 90 days (16.6% vs 14.0%, aOR 0.94, 95% CI 0.35-2.44, p = 0.81) between the groups. The median (interquartile range) groin puncture to recanalization time was significantly longer in the antegrade group (59 [43-90] minutes vs 49 [35-73] minutes, p = 0.036).

Conclusions: The retrograde approach was associated with faster recanalization times with a similar functional and safety profile when compared with the antegrade approach in patients with acute ischemic stroke with TL.

Keywords: carotid artery; endovascular neurosurgery; intervention; ischemic stroke; tandem lesions; thrombectomy; vascular disorders.

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Figures

Fig. 1.
Fig. 1.
Flowchart of the patients included in the study.
Fig. 2.
Fig. 2.
Distribution of mRS scores at 90 days. Unadjusted and adjusted differences in shift to favorable mRS score were used to compare the antegrade and retrograde groups. *Adjusted for age, initial NIHSS score, IVT, mTICI score, and sICH.
See this image and copyright information in PMC

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